新生儿沙雷菌感染4例

Clinical Analysis of Serratia Infections in 4 Newborn Infants

目的分析新生儿沙雷菌感染的临床特征及预后,提高对沙雷菌感染的认识。方法对2008年7月-2009年2月在本院新生儿中心住院的4例沙雷菌感染新生儿的临床表现、实验室检查、诊断、并发症、治疗及预后进行分析。结果4例患儿中3例血培养为黏质沙雷菌(其中早产儿1例),1例脑脊液培养为液化沙雷菌。4例患儿的主要临床表现为发热、抽搐、反应差,外周血白细胞和CRP显著增高,其中1例早产儿以血小板减少为著。2例单纯败血症患儿,经至少2周的三代头孢菌素抗炎治疗后,治愈;另2例败血症合并细菌性脑膜炎患儿,1例为早产儿,1例为液化沙雷菌感染,影像学证实合并脑膜脑炎及脑脓肿,随访有神经行为异常。结论沙雷菌作为一种条件致病菌,可引起严重的新生儿感染。合并脑膜炎者,应监测随访,注意高发的神经系统后遗症。

Objective To analyze the clinical characteristic and prognosis of Serratia infections in newborn infants and increase awareness of Serratia infections.Methods The clinical manifestations,diagnosis,complications,treatment and prognosis of Serratia infections were analyzed in 4 hospitalized newborn infants in neonatology center from Jul.2008 to Feb.2009.Results Among the 4 cases,blood culture revealed Serratia marcescens in 3 cases（1 case was preterm infant）,cerebral spinal fluid culture revealed Serratia liquefacien in the fourth case.The main clinical manifestations were fever,convulsion and poor response,WBC and CRP were much higher,while obvious thrombocytopenia was only found in the preterm infant.Two cases of septicemia infection alone recovered after the treatment of the third-generation cephalosporin for at least 2 weeks,while the other 2 cases of septicemia infection combined with purulent meningitis,included 1 case of preterm infant and 1 case of Serratia liquefacien infection,developed meningoencephalitis and brain abscess confirmed by serial imaging,both of which had poor neurological sequelaes.Conclusions As a opportunistic pathogen,Serratia can cause severe infection in newborns.The patients complicated with meningitis should be followed up and pay more attention to the high incidence of neurological sequelaes.